What diseases does CBD treat
Indications: For which diseases can cannabis be used as a medicine? (4/7)
Exceptions are if there is no alternative that corresponds to the medical standard or the attending physician does not consider another therapy to be sensible. In addition, there must be a reasonable prospect that the course of the disease will improve for the patient and that serious symptoms will be alleviated.
TK report summarizes the study situation
A current scientific report on cannabis as medicine prepared on behalf of the TK works on the previous study situation. He comes to the conclusion that the following diseases and areas of application represent a conceivable indication for a therapy with medical cannabis:
- chronic pain,
- Spasticity in multiple sclerosis and paraplegia,
- Nausea and vomiting after chemotherapy as well
- Increased appetite in HIV / AIDS.
Possible indications for medicinal cannabis are therefore
- Anxiety disorders
- Sleep disorders,
- Tourette Syndrome and
- ADHD - even if there is hardly any scientific evidence.
On the other hand, cannabis is not effective in the indications
- Glaucoma and
- Bowel disease.
Further information on individual diseases and areas of application:
Cancer patients are often stressed by nausea and vomiting during chemotherapy. The research on this is correspondingly intensive.
The role of cannabinoids in this context has been scientifically observed since the 1970s, because their mechanisms of action differ from conventional antiemetics (drugs to suppress nausea and nausea).
However, even in overview studies of the current research situation, ambiguities remain: While some authors ascribe a scientifically proven effect (evidence) to medical cannabis on nausea caused by chemotherapy, others cannot yet recommend therapy with cannabinoids. They emphasize that there are currently safer and more effective antiemetics available for post-chemotherapy nausea and vomiting.
The analysis of various systematic reviews on medical cannabis for pain still reveal some uncertainties. The effect on neuropathic pain (also: nerve pain) is most likely scientifically proven.
In addition, cannabis appears to be superior to placebo as a medicine for cancer-related pain.
A review article on pain in multiple sclerosis from 2017 could not show any statistically significant differences compared to placebo treatment. Overall, however, there are too few studies to be able to derive clear recommendations.
In the case of acute postoperative pain, there is no greater benefit from medicinal cannabis than placebos.
Several recent meta-studies emphasize the need for long-term studies on the safety and effectiveness of cannabis as a medicine, as well as the optimal dosage for neuropathic pain.
Fibromyalgia, musculoskeletal pain, and rheumatoid arthritis
Studies on the use of cannabinoids in fibromyalgia, musculoskeletal pain, rheumatoid arthritis and tumor-related pain are currently so thin that scientific proof of their effectiveness has not been provided. The results so far are based on studies with rather small patient groups of 23 to 50 patients per study and short-term investigation periods.
Some studies recommend the use of cannabinoids in pain management and palliative medicine as an individual therapeutic attempt, but point to side effects such as dizziness, confusion or psychosis.
Cramps / spasticity
The effectiveness of medicinal cannabis in spasticity (as a result of multiple sclerosis or paraplegia) could not be proven for the drugs investigated so far, at least with objective test criteria. The evidence is therefore based on a rather subjective effect.
A summary of the existing reviews on medical cannabis for spasticity comes to the conclusion that 30 percent of the patients (mainly with multiple sclerosis) reported an alleviation of symptoms after therapy and about half reported a general change that was perceived as positive. Only about 35 percent felt better among patients who received placebos. However, the difference is also attributed to the euphoric or sedative effects of medicinal cannabis.
Studies on the effects of cannabinoids on seizures in the context of amyotrophic lateral sclerosis (ALS) are insufficient to provide reliable results.
Following promising reports on the effects of cannabis in individual cases, interest in the treatment of epilepsy with cannabis has increased over the past decade. However, the development of a suitable formulation for oral ingestion proved to be difficult. There may also be interactions with other drugs.
Nevertheless, current study results support the effectiveness of cannabinoids in Dravet and Lennox-Gastaut syndromes. In addition, further methodologically high-quality studies on cannabis in focal epilepsy have not yet been completed.
Depression and anxiety
The current state of studies on the treatment of depression with medical cannabis is very poor. Although these studies often show that cannabinoids are superior to placebos, these few studies show an overall higher risk of biasing the results.
So far, there is very little research on cannabis as a medicine for attention deficit / hyperactivity disorder (ADHD). Above all, experience reports have been published. For example, a case study showed that a patient with strong ADHD symptoms (inappropriate behavior, inattention) could behave inconspicuously after consuming THC.
A randomized experimental pilot study examined the effect of the drug Sativex® compared to placebo in 30 adults with ADHD. The results on the cognitive performance and the activity level of the patients did not differ significantly.
The symptoms of hyperactivity and impulsiveness, on the other hand, improved in the Sativex® group.
More studies are needed to demonstrate a possible effect of cannabis on symptoms of ADHD in adults. In addition, future research will have to provide insights into the endocannabinoid system and ADHD.
Increased appetite in HIV / AIDS and cancer patients
In HIV / AIDS, some studies suggest that medicinal cannabis has a mild weight-stimulating effect. Individual studies also show a slight increase in appetite in cancer patients treated with palliative care, but this was not significant compared to placebo.
A recent review comes to the conclusion that there is not yet sufficient scientific evidence for the use of cannabinoids in the loss of appetite in HIV / AIDS or cancer patients. Previous studies have tended to include short observation periods in small patient groups.
Only a few studies are available on the use of medical cannabis in intestinal diseases. There is not yet sufficient scientific evidence that medical cannabis improves the primary symptoms of Crohn's disease or irritable bowel syndrome.
The effect of medical cannabis on sleep disorders has not been the main subject of scientific research. In isolated cases, studies - for example on medicinal cannabis for pain - have recorded the effect on sleep as a secondary parameter. However, it could not be proven that medicinal cannabis works with disturbed sleep. At most, there can be talk of a possible benefit.
There are isolated studies that establish a significant connection between reduced tic intensity in patients with Tourette's syndrome and the administration of medicinal cannabis.
However, studies with larger numbers of patients and longer treatment periods as well as with a direct comparison of different cannabinoids are necessary in order to substantiate effectiveness and safety in a more differentiated manner.
There are no reliable studies that show the effectiveness of cannabis as a medicine for psychosis symptoms.
Preliminary data on the effectiveness of medicinal cannabis in schizophrenia appear promising. It is specifically about the active ingredient cannabidiol (CBD).
While long-term use of cannabis is considered a risk factor for schizophrenia, CBD does not appear to have any psychedelic effects.
Case studies suggest that the antipsychotic effect of CBD in acute schizophrenia is comparable to the effect of the neuroleptic amisulpride - but shows fewer side effects. Even so, more large-scale clinical trials are needed to examine the efficacy and safety of CBD in schizophrenia.
There is currently no scientific evidence on the effectiveness of cannabinoids in the treatment of symptoms of dementia. A systematic review on this topic, for example, emphasizes the urgent need for relevant studies.
There are very few studies on the effectiveness of medicinal cannabis in glaucoma and there is no indication that the administration of cannabinoid-containing substances affects intraocular pressure differently than placebos.
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